[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) › Pancreatic duct [Digestive system](https://durgical.com/en/anatomy/system/digestive-system/) · [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) # Pancreatic duct The pancreatic duct runs through the length of the [pancreas](https://durgical.com/en/anatomy/pancreas/) and carries its digestive juice to the [duodenum](https://durgical.com/en/anatomy/duodenum/), joining the bile duct at the ampulla. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=abdomen&select=pancreatic_duct&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The main duct running the length of the pancreas, joining the bile duct at the ampulla (and a smaller accessory duct). ## What it does Carries digestive enzymes to the duodenum. ## Key points - Double duct sign: the common bile duct and the main pancreatic duct both dilated, classically from a tumour of the pancreatic head or ampulla - Chronic pancreatitis on imaging: an irregular, dilated main duct with clubbed side branches ('chain of lakes') and calcified stones - Normally only a few millimetres wide, widest in the head (about 3 mm is a commonly quoted limit; texts vary); a dilated duct means something is blocking it downstream ## Key facts **Where** Main duct (Wirsung) runs tail to head; accessory duct (Santorini) in upper head **Function** Carries pancreatic juice to the duodenum **Drains** Exocrine pancreas **Into** Main: with common bile duct at major papilla; accessory: minor papilla about 2 cm higher (varies: pancreas divisum) ## Relations **Course** Starts in the tail near the splenic hilum, runs through the body and neck collecting side branches in a herringbone pattern, then turns down and back in the head to meet the [common bile duct](https://durgical.com/en/anatomy/bile-duct/) **Above** Accessory pancreatic duct (Santorini) in the upper head, opening at the minor duodenal papilla and usually still connected to the main duct **Behind** [Splenic vein](https://durgical.com/en/anatomy/splenic-vein/) behind the body and tail; in the head, the common bile duct approaches it from the right and behind ## How to find it Reached at ERCP through the major duodenal papilla on the medial wall of the second part of the duodenum; the accessory duct opens on the smaller minor papilla a little higher up. In surgery it is seen in the cut surface of the pancreatic neck, and intraoperative ultrasound helps to find a narrow duct. ## On imaging MRCP shows the duct and its branches without injection; with secretin it shows pancreas divisum and outflow better. ERCP fills it directly when treatment is needed (stones, strictures, leaks). On contrast CT, a dilated duct with an abrupt cut-off points to a mass. ## Common problems - Acute pancreatitis, most often from gallstones or alcohol: severe upper abdominal pain spreading to the back. - Pancreatic cancer. - Diabetes (islet cells). ## How it is diagnosed Blood tests (lipase), CT, MRI, endoscopic ultrasound. ## Treatment - Hospital care for pancreatitis; remove gallstones; surgery for some tumours. ## Clinical notes - A torn duct after pancreatitis or trauma leaks pancreatic juice: pseudocyst, pancreatic ascites or fistula; a stent placed at ERCP can bridge the leak - In chronic pancreatitis, duct stones and strictures can cause pain from high pressure in the duct; they are treated endoscopically or by drainage surgery (lateral pancreaticojejunostomy) - After a Whipple procedure the duct of the remaining pancreas is joined to the [jejunum](https://durgical.com/en/anatomy/jejunum/) or [stomach](https://durgical.com/en/anatomy/stomach/); leak from this join (pancreatic fistula) is the main complication ## Anatomical variants - Pancreas divisum: the ventral and dorsal ducts do not fuse, so most juice drains through the accessory duct and the minor papilla; usually silent, possibly linked to recurrent pancreatitis - The accessory duct may be absent or end blindly before reaching the duodenum ## Development The main duct is formed by the duct of the ventral bud plus the distal part of the dorsal duct; the accessory duct is what remains of the proximal dorsal duct. Pancreas divisum is the failure of this union. ## Related conditions - [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/) - [Chronic pancreatitis](https://durgical.com/en/conditions/chronic-pancreatitis/) - [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/) ## Test yourself Think of the answer, then tap the question to see it. ## Where do the main and the accessory pancreatic ducts open into the duodenum? The main duct (Wirsung) joins the common bile duct at the major duodenal papilla; the accessory duct (Santorini) opens at the minor papilla, about 2 cm higher. ## What is the double duct sign? Dilatation of both the common bile duct and the main pancreatic duct, classically from a tumour of the pancreatic head or the ampulla blocking them downstream. ## What is pancreas divisum? Failure of the ventral and dorsal pancreatic ducts to fuse, so most pancreatic juice drains through the accessory duct and minor papilla; usually silent, possibly linked to recurrent pancreatitis. ## How does the main pancreatic duct look on imaging in chronic pancreatitis? Irregular and dilated, with clubbed side branches (a «chain of lakes») and calcified stones; stones and strictures can cause pain from high pressure in the duct. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/pancreatic-duct/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** ductus pancreaticus; ductus pancreaticus accessorius TA2 3129 **Official Spanish (DeCS)** Conductos pancreáticos DeCS D010183 **English (TA2)** Pancreatic duct **Also called** pancreatic ducts · ductus pancreaticus major · ductus Wirsungi · duct of Wirsung ## Related - [Common bile duct](https://durgical.com/en/anatomy/bile-duct/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=10371&filter=ths_termall&q=Conductos%20Pancre%C3%A1ticos); [Anatomy, Abdomen and Pelvis: Biliary Ducts](https://www.ncbi.nlm.nih.gov/books/NBK459246/); [23.6 Accessory Organs in Digestion: The Liver, Pancreas, and Gallbladder](https://openstax.org/books/anatomy-and-physiology-2e/pages/23-6-accessory-organs-in-digestion-the-liver-pancreas-and-gallbladder) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/pancreatic-duct/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/pancreatic-duct/